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From the 10/8/2021 release of VAERS data:

This is VAERS ID 916466



Case Details

VAERS ID: 916466 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Montana  
Vaccinated:2020-12-28
Onset:2020-12-31
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient is below the minimum recommended age of 18. The patient is 17 years of age. The immunizing pharmacist neglected to catch that the patient was 17 before giving the vaccine. No adverse reactions have been reported - patient has been checked in and is fine with no symptoms or side effects. Simply reporting the dosing of an underage individual.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=916466

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